Physiological Adaptation Q 67
An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend?
A. Massaging the groin area twice a day until the fluid is gone.
B. Referral to a surgeon for repair.
C. No treatment is necessary; the fluid is reabsorbing normally.
D. Keeping the infant in a flat, supine position until the fluid is gone.
Correct Answer: C. No treatment is necessary; the fluid is reabsorbing normally.
A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases the fluid reabsorbed within the first few months of life and no treatment is necessary.
Option A: Congenital hydrocele tends to be intermittent as it usually reduces when lying flat due to drainage of hydrocele fluid into the peritoneum. However, applying pressure on the congenital hydrocele does not reduce it. At birth, around 80-90% of term male infants possess a patent processus vaginalis. This figure declines steadily to settle at approximately 25-40% at two years of age.
Option B: Surgery is the treatment of choice for hydrocele, and it is warranted when hydrocele becomes complicated or symptomatic. For congenital hydroceles, herniotomy is performed, provided they do not resolve spontaneously. On the other hand, acquired hydroceles subside when the primary underlying condition resolves.
Option D: Placing the infant in a supine position would have no effect. The majority of patients with hydrocele present with the complaint of painless scrotal swelling rendering the testes impalpable with positive transillumination and fluctuation. The examiner should look at this swelling in both the supine and upright positions.